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Does the Internet harm children's health? A critical review of the evidence

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Presentation delivered at MeCCSA 2013 by Dr. Vera Slavtcheva-Petkova, highlighting findings of a paper co-authored with Dr. Monica Bulger and Dr. Victoria Nash of the Oxford Internet Institute

Abstract: Moral panics about the Internet’s “harmful effects” have been ongoing in current years, recently exacerbated by a UK parliamentary inquiry into online child protection. Is there scientific evidence supporting these fears? Does the Internet harm children and especially their health? This paper will present the findings from a narrative review of more than 300 journal articles discussing the scale and scope of online harms that young people experience. We will first present the three main types of harms identified in the literature: health-related harms, sex-related harms and cyber-bullying. Then the paper will focus in more detail on the evidence about health-related harms incurred as a result of online risks. We not only identify the kinds of health harms discussed in the literature – mainly related to pro-eating disorder websites, self-injury websites and problematic Internet use – but we also investigate whether and how the researchers operationalize harm. We also scrutinize the research methods used in the studies, which tend to differ significantly among the disciplines studied.

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Does the Internet harm children's health? A critical review of the evidence

  1. 1. Does  the  Internetharm  children’shealth?Dr  Vera  Slavtcheva-­‐Petkova,  University  of  ChesterDr  Monica  Bulger,  Dr  Victoria  Nash,  OxfordInternet  Ins4tute,  University  of  Oxford
  2. 2. Contents• Child  protec4on  and  online  harms:  Academic and  policy  context• Methods• Scope,  scale  and  opera4onalisa4on  of  health-­‐ related  harms• Conclusions
  3. 3. Academic  context• Growing  body  of  research  on  level  and  character of  Internet  by  under  18s,  and  nature  of  risks  and opportuni4es  experienced  (e.g.,  Livingstone  & Haddon,  2009;  Schrock  &  Boyd,  2008)• Research  suggests  that  risks  are  greatest  for  those most  vulnerable  offline,  and  that  overall,  the opportuni4es  of  Internet  use  outweigh  risks  (e.g. Mitchell  et  al.,  2010,  Livingstone  et  al.,  2011)• Real  lack  of  research  which  quan4fies  or  analyses level  of  actual  harm  rather  than  poten4al  risk.
  4. 4. Policy  context• Wide  array  of  policy  measures  across  Europe:  hotlines for  repor4ng  child  abuse  images,  industry  codes  of conduct  regula4ng  use  of  mobile  content  and  services, and  increasing  provision  of  parental  controls  by  ISPs.• Much  of  this  is  result  of  self  or  co-­‐regula4on• Possible  and  actual  conflicts  with  other  rights,  e.g. freedom  of  expression,  legal  due  process.• Policy  purportedly  informed  by  research  (e.g.  mul4-­‐ stakeholder  UK  Council  for  Child  Internet  Safety),  but suscep4ble  to  media  pressure  and  “moral  panics”
  5. 5. Perceived  risks  vs.  actual  harms “While  new  discoveries  almost  always  have  both  benefits  anddisadvantages,  breathless  nega4ve  coverage  of  technology  frightensparents,  prevents  teenagers  from  learning  responsible  use,  and  fuels panics,  resul4ng  in  misguided  or  uncons4tu4onal  legisla4on”  (Marwick 2008).
  6. 6. Our  study• Evidence  on  the  extent  of  harms experienced  by  children  as  a  result  of online  risks:  A  cri4cal  synthesis  of  research• Funded  by  the  Oxford  University  Presss Fell  Fund• A  review  of  empirical  studies  of  harms associated  with  young  people’s  (under 18s)  Internet  use,  published  in  English between  1997-­‐2012  +  interviews  with  key stakeholders
  7. 7. Methods• Keywords:  “harm  AND  Internet  AND  children”,  “harm AND  Internet  AND  adolescents”,  “harm  AND  Internet AND  minors”,  “harm  AND  Internet  AND  teens”  and “harm  AND  Internet  AND  teenagers”• Categories  for  inclusion:1.Empirical  work2.Published  in  peer-­‐reviewed  journal3.Main  focus  of  study  was  young  people  (aged  under  18)4.Addressed  Internet  use5.Addressed  incidents  of  harm  related  to  online interac4ons
  8. 8. Methods• Original  search  yielded  over  4,000  publica4ons• Aher  a  first-­‐pass  review,  corpus  narrowed  to  271 studies.• 271  were  reviewed  but  only  148  ar4cles  were fully  coded  aher  strict  applica4on  of  the inclusion  criteria.• Coding  framework  adapted  from  the  EU  Kids Online  public  repository.    It  included  21  items, including  details  of  method,  target  popula4on, context  and  how  and  whether  harm  was opera4onalised.
  9. 9. Three  categories  of  harms• Three  main  categories  of  harms:1.Health-­‐related  harms:  63  ar4cles1.Sex-­‐related  harms:  49  ar4cles1.Cyberbullying  –  36  ar4cles
  10. 10. Health  studies:  Methods
  11. 11. Scope  of  harms
  12. 12. Operationalization  of  harm• Harm  is  opera4onalized  in  less  than  half  of  the  studies  – 44.5%• Self-­‐harm:  The  most  common  defini4on  (33.3%  of  all studies  and  75%  of  those  that  opera4onalize  the  term)• Examples:• “Parasuicide”,  “self-­‐mu4la4on”  or  “self-­‐injury”  (Adams et  al.,  2005,  p.  1293)• “A  form  of  ac4vely  managed  self-­‐destruc4ve  behavior that  is  not  intended  to  be  lethal”,  which  “subsumes  an extensive  range  of  behaviours”  such  as  self-­‐mu4la4on, self-­‐injurious  behavior,  deliberate  self-­‐harm  and  self-­‐ wounding  (Murray  et  al.,  2008,  p.  29)
  13. 13. Other  deCinitions  of  harm2. “Desensi4za4on  to  violence  in  real  life  and impairment  in  the  process  and  outcome  of moral  evalua4on”3. Physical  harm4. Emo4onal  harm
  14. 14. Scale  of  Pro-­‐ED  harms• Much  of  the  discussion  pertains  to  perceived  or  poten,al harm  rather  than  evidence  of  actual  harm• Pro-­‐ea4ng  disorder  websites:1.Even  “suppor4ve”  websites  contain  poten4ally  harmful content  –  “pro-­‐ED  websites  tend  to  be  perceived  as suppor4ve  by  users,  but  instead  appear  to  exacerbate  or  main users’  ea4ng  disorder  symptoms”2.Three  “possible  risks”:a.“Opera4on  under  the  guise  of  ‘support’b.Reinforcement  of  disordered  ea4ngc. Preven4on  of  help-­‐seeking  and  recovery”  (Rouleau  and  von Ranson,  2011,  p.  525)
  15. 15. Scale  of  Pro-­‐ED  harms• 85%  of  the  pro-­‐ea4ng  disorder  websites  contain “thinspira?on”  material  –  images  of  very  thin  models  or celebri4es  used  to  inspire  weight  loss,  70%  have  “?ps  and tricks”  on  die?ng  and  fas?ng  or  purging,  laxa4ves  and  pills (Borzekowski  et  al.,  2010)• 96%  of  users  of  pro-­‐ea4ng  disorder  websites  and  46.4%  of users  of  pro-­‐recovery  sites  report  “learning  new  weight  loss or  purging  techniques”  (Wilson  et  al.,  2006,  p.  e1635)• 19.2%  of  users  say  they  feel  the  pro-­‐ea4ng  disorder  websites are  harmful  to  them  because  they  encourage  the disorders/compe44on  among  par4cipants  and  have  “nega4ve impact  on  self-­‐effect”  (Csipke  and  Horne,  2007,  p.  200)
  16. 16. Scale  of  Pro-­‐ED  harms• Talbot  (2010)  argues  that  viewing  pro-­‐ea4ng  disorder websites  is  linked  to  a  number  of  nega4ve  effects:1.“Higher  levels  of  die4ng  and  exercise2.Higher  levels  of  drive  for  thinness,  body  dissa4sfac4on  and perfec4onism3.Posi4ve  correla4on  between  viewing  pro-­‐ED  websites,  disease dura4on  and  hospitaliza4ons”  (p.  686)BUT:1.Viewing  pro-­‐ED  websites  may  INCREASE  ea4ng  disorder behaviour  but  MIGHT  NOT  CAUSE  it2.More  research  is  needed  to  determine  if  these  websites  DO HARM  and  if  so,  TO  WHOM  and  OF  WHAT  FORM  (Talbot, 2010,  p.  694)
  17. 17. Scale  of  self-­‐harm• A  “normalizing”  and  a  “pathologizing”  discourse (Franzén  &  Goszén,  2011,  p.  279)• Lisle  evidence  regarding  the  prevalence  of  self-­‐ injurious  behavior  and  its  rela4onship  to  use  of  self-­‐ harm  websites  or  forums• 80%  of  the  users  of  self-­‐harm  message  boards  are found  to  be  between  14  and  20  years  old  (Whitlock, Powers,  &  Eckenrode,  2006).• The  typical  adolescent  self-­‐injurer  is  female,  ohen with  a  history  of  abuse  and  an  ea4ng  disorder,  most commonly  cutng  her  arms  and  legs  and  hiding  it.
  18. 18. Scale:  pro-­‐suicidal  sites• Much  more  conclusive  in  the  claims  about  harms• A  meta-­‐study  (Durkee  et  al.,  2011)  concludes that  “pro-­‐suicide  websites  and  online  suicide pacts”  are  “high-­‐risk  factors  for  facilita4ng suicidal  behaviours,  par4cularly  among  isolated and  suscep4ble  individuals”  BUT  some  forums provide  opportuni4es  for  people  to  meet  others with  similar  experiences,  “wherein  their thoughts  and  feeling  are  not  condemned  nor lectured  about”  (p.  3944)
  19. 19. Scale  of  “Internet  addiction”• 35%  of  people  with  Problema4c  Internet  experience are  <18• BUT  “virtually  all  of  the  Internet  problem  behaviors” are  “extensions  of  problem  behaviors  that  pre-­‐ existed  the  advent  of  the  Internet”  (Mitchell, Becker-­‐Blease,  &  Finkelhor,  2005,  p.  506)• The  typical  problema4c  Internet  user  is  a  teenager who  spends  most  of  his/her  4me  on  the  computer, including  at  night.  He/she  is  socially  isolated  and plays  games  12-­‐14  hours  a  day• A  counsellor:  “It’s  the  same  thing  as  with  drug addicts”  (Acier  and  Kern,  2011,  p.  986)
  20. 20. Conclusions• It  seems  indisputable  that  some  children  experience a  variety  of  health  harms  as  a  result  of  using  the Internet.• Documented  examples  include  young  people assisted  or  encouraged  in  their  suicide  asempts aher  visi4ng  pro-­‐suicide  forums  and  young  girls encouraged  to  maintain  or  exacerbate  their  ea4ng disorders  or  self-­‐injurious  behavior.• Rela4vely  low  numbers  –  specific  case  studies  based on  interviews  with  health  professionals  and/or medical  records
  21. 21. Conclusions• Interes4ng  textual  analysis  studies  and  surveys,  sugges4ng high  prevalence  of  poten4al  harms  and  risks  but  lisle evidence  on  actual  harms,  especially  in  rela4on  to  low-­‐risk children• For  example,  whether  and  how  are  healthy  children  affected by  using  ea4ng  disorders  websites  –  are  they  “harmed”  by  the pro-­‐ED  websites?• Limita4ons  of  studies:  reliance  on  surveys  –  they  tell  us  a  lot about  risks  and  perceived  harms  but  lisle  about  actual  harms• Limita4ons  of  our  study:  focus  strictly  on  harms  and  studies that  use  the  term,  hence  poten4ally  relevant  studies  might have  been  omised
  22. 22. Any  questions?•Dr  Vera  Slavtcheva-­‐Petkova,  v.petkova@chester.ac.uk•Dr  Monica  Bulger,  monica.bulger@oii.ox.ac.uk•Dr  Victoria  Nash,  victoria.nash@oii.ox.ac.uk

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